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If you are one of the three million employees injured in the workplace every year, are you confident that the medical treatment prescribed for your injury/illness is going to be effective?
You can hope that is the case, but you would do well to get familiar with the terms “differential diagnosis” and “science-based medicine” if you want to improve the odds your treatment will cure what ails you.
A differential diagnosis is a concise, technical description of the cause of the injury and is based on objectively defined laboratory, radiologic and pathological facts.
That’s a clumsy way of saying the doctor should base his diagnosis on science-based facts and not guesses or assumptions.
In other words, workers comp doctors should take your medical history and lab test results into consideration before making a diagnosis. The doctor should not just hear your complaints about back pain, for example, make an assumption that it’s like all other back pain complaints and prescribe the same treatment they always use for back injuries.
If your doctor examined you and prescribed treatment, but your health isn’t improving in the recommended recovery period, it might be time to visit another doctor, or at least re-visit the situation with your current doctor and see if he did a thorough enough examination to make the right diagnosis.
“It is a doctor’s responsibility to make a correct diagnosis and provide safe, effective care,’’ Dr. David Randolph told an audience of health and insurance workers at the 74th annual Workers’ Compensation Education Conference in August of 2019. “If, after a few days or weeks, the patient’s symptoms are not getting better, you should go back and start the process all over again.”
To be fair, differential diagnosis isn’t always needed. For example, if you fell and broke your arm, that would seem pretty straight forward to diagnose. But if you developed recurring pain in a leg without such a history, more careful consideration would be in order.
Studies Show Incomplete Diagnosis Common
Dr. Randolph and Dr. Trang Nguyen, a husband-wife research team from Cincinnati, studied over one million workers compensation claims in Ohio for an 18-year period (2000-2018) and found evidence that some doctors in workers comp cases were:
- Doing incomplete workups
- Drawing faulty conclusions
- Prescribing ineffective solutions for their patients
The result was a number of patients who might have expected to miss a few days or even a few weeks of work, instead were out for months, years or never even got back to work.
“Our concern with workers compensation cases is that you never see these injured people get a differential diagnosis,” Dr. Nguyen said. “They’re not getting diagnostic lab testing documented in their record. They’re not getting a complete work up and that is causing problems with their treatment.”
In one case cited by the doctors, a 42-year-old worker hurt his ankle stepping off a ladder in 2002 and was misdiagnosed so many times, received so many prescriptions and treatments that his feet and legs were grossly swollen and there were red rash marks all over his hands. He eventually had to use a wheelchair and crutches to get around. All this from an ankle injury.
It turned out that his complaints were due to an undiagnosed illness which would likely have responded well to earlier intervention. Oh, and he never returned to work.
“When you are treating and treating and treating a patient and they’re not getting better, somebody needs to stop and ask: ‘Do we have the right diagnosis,’ ” Dr. Nguyen said,
Beware of ‘I Know It When I See It’ Diagnosis
The medical process used in examining workers comp claims is what Dr. Randolph and Dr. Nguyen warned people to keep an eye on. They said that too many doctors in their study relied on assumptions – “I know it when I see it” – instead of using science-based medicine to diagnose and treat patients.
For example, when a patient told them about an accident at work and complained that their back hurt, that was all the doctor had to hear. He/she quickly wrote a prescription to relieve back pain and moved on to the next case. Dr. Randolph and Nguyen said patients deserve far more attention than that.
They insist that doctors ask more questions about the patient’s medical history, run more lab and diagnostic tests and see if there aren’t other factors that could be contributing to or causing the patient to complain.
“When someone complains about their back hurting and says it’s from all the lifting they do on the job, they might be right,” Dr. Randolph said. “But what if they’re diabetic? Overweight? Seldom exercise and have been having problems with their back for years?
“If the treating doctor doesn’t do a full physical examination and medical history, he might be treating the wrong problem and prescribe some kind of muscle relaxer that makes things worse.”
“With medicine, the diagnosis should be based on objective diagnostic testing and laboratory pathology reports, not on a matter of opinion,” Dr. Nguyen said. “What we’re trying to say is that with all the treatments we’re providing, are we improving outcomes and is it safe for the patient? Any medical intervention has to be safe for the patient.”
